36C24518R0176-0001005.docx

Past Performance Information

OFFEROR INSTRUCTIONS: A separate record must be completed for each Past Performance Information and Survey; Offeror must directly send to the evaluator, requesting they complete and return as indicated on the attached Past Performance Survey, no later than, July 9th, 2018 to Jabbar.Pringle@va.gov. Further, Offeror must include a copy of each requested Past Performance Information page with proposal submission.

Name of Offeror being evaluated:

Address of Offeror:

Contract Details (i.e. Contract #/ Delivery or Task Order #, Title, Location, etc.)

Name of the Evaluator:

Position held or function in relation to project:

Evaluator’s Company Name, Address and Phone number:

FAX Number:

Please complete and return to: ____________________________ No Later Than: ____________________________

PAST PERFORMANCE SURVEY

REFERENCE INSTRUCTIONS: The Department of Veterans Affairs is considering the Offeror listed above for award of a VA contract. Your comments would be appreciated regarding this firm’s past performance. Your comments are considered Source Selection Sensitive; therefore, you are advised that the Federal Acquisition Regulation (15.506) prohibits the release of the names of individuals providing reference information about Offeror’s past performance. Please help us by completing this Past Performance Survey and returning it no later than July 9th, 2018 via Email with Solicitation number 36C24518R0176 in subject line to: Jabbar.Pringle@va.gov

Please evaluate the past performance using only the following ratings without variation. If the rating is Marginal or Unacceptable, please provide additional information in the appropriate block or in the remarks section of this form.

“O” = Outstanding = Performance greatly exceeded the contract requirements

“A” = Above Average = Performance exceeded the contract requirements

“S” = Satisfactory = Performance met the contract requirements

“M” = Marginal = Performance met the minimum contract requirements but some material aspects of the contractor’s performance were less than satisfactory

“U” = Unacceptable = Performance was poor and/or did not satisfy contract requirements

Please write in “not applicable” or “neutral” if unable to rate a certain question.

Q4. To what extent did the contractor display technical expertise?

O A S M U

T1. To what extent was contractor able to meet the performance schedule:

O A S M U

T2. What extent was contractor flexible in responding to changing needs?

O A S M U

T5. Have any cure notices, show cause letters, suspension of payment, or termination been issued? If yes, please explain.

Yes No

C1. Would you award another contract to the party being evaluated? If no, please explain:

C2. Was the customer satisfied with the end product? If no, please explain:

C3. To what extent did contractor notify you of problems or potential problems?

O A S M U

Additional Remarks:

Signature of Evaluator: Date of Evaluation:

Print Name of Evaluator:

Your signature is required. Please print/sign/date and either scan and email to Jabbar.Pringle@va.gov

Thank you for your time and due diligence.